Dyck Roland F, Karunanayake Chandima, Janzen Bonnie, Lawson Josh, Ramsden Vivian R, Rennie Donna C, Gardipy P Jenny, McCallum Laura, Abonyi Sylvia, Dosman James A, Episkenew Jo-Ann, Pahwa Punam
Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
BMC Public Health. 2015 Dec 9;15:1222. doi: 10.1186/s12889-015-2551-2.
Aboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization. The purpose of this study was to investigate the possible role of discrimination, residential school attendance and cultural disruption on diabetes occurrence among First Nations adults.
This 2012/13 cross sectional survey was conducted in two Saskatchewan First Nations communities comprising 580 households and 1570 adults. In addition to self-reported diabetes, interviewer-administered questionnaires collected information on possible diabetes determinants including widely recognized (e.g. age, sex, lifestyle, social determinants) and colonization-related factors. Clustering effect within households was adjusted using Generalized Estimating Equations.
Responses were obtained from 874 (55.7 %) men and women aged 18 and older living in 406 (70.0 %) households. Diabetes prevalence was 15.8 % among women and 9.7 % among men. In the final models, increasing age and adiposity were significant risk factors for diabetes (e.g. OR 8.72 [95 % CI 4.62; 16.46] for those 50+, and OR 8.97 [95 % CI 3.58; 22.52] for BMI 30+) as was spending most time on-reserve. Residential school attendance and cultural disruption were not predictive of diabetes at an individual level but those experiencing the most discrimination had a lower prevalence of diabetes compared to those who experienced little discrimination (2.4 % versus 13.6 %; OR 0.11 [95 % CI 0.02; 0.50]). Those experiencing the most discrimination were significantly more likely to be married and to have higher incomes.
Known diabetes risk factors were important determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not predictive of diabetes on an individual level. In contrast, those experiencing the highest levels of discrimination had a low prevalence of diabetes. Although the reasons underlying this latter finding are unclear, it appears to relate to increased engagement with society off-reserve which may lead to an improvement in the social determinants of health. While this may have physical health benefits for First Nations people due to improved socio-economic status and other undefined influences, our findings suggest that this comes at a high emotional price.
加拿大的原住民（第一民族、梅蒂斯人和因纽特人）正经历糖尿病及其并发症的流行，但对于殖民化相关因素的影响却知之甚少。本研究的目的是调查歧视、寄宿学校就读经历和文化中断在第一民族成年人糖尿病发生中的可能作用。
这项2012/13年的横断面调查在萨斯喀彻温省的两个第一民族社区进行，涵盖580户家庭和1570名成年人。除了自我报告的糖尿病情况外，由访谈员管理的问卷收集了有关可能的糖尿病决定因素的信息，包括广泛认可的因素（如年龄、性别、生活方式、社会决定因素）以及与殖民化相关的因素。使用广义估计方程对家庭内部的聚类效应进行了调整。
共获得了居住在406户（70.0%）家庭中的874名（55.7%）18岁及以上男性和女性的回复。女性糖尿病患病率为15.8%，男性为9.7%。在最终模型中，年龄增长和肥胖是糖尿病的重要危险因素（例如，50岁及以上者的比值比为8.72[95%置信区间4.62；16.46]，体重指数30及以上者的比值比为8.97[95%置信区间3.58；22.52]），在保留地居住时间最长也是如此。寄宿学校就读经历和文化中断在个体层面上并不能预测糖尿病，但与很少受到歧视的人相比，受到最多歧视的人糖尿病患病率较低（2.4%对13.6%；比值比0.11[95%置信区间0.02；0.50]）。受到最多歧视的人结婚的可能性显著更高，收入也更高。
已知的糖尿病危险因素是第一民族人群糖尿病的重要决定因素，但寄宿学校就读经历和文化中断在个体层面上并不能预测糖尿病。相反，受到最高程度歧视的人糖尿病患病率较低。尽管后一发现背后的原因尚不清楚，但这似乎与在保留地之外更多地融入社会有关，这可能会改善健康的社会决定因素。虽然这可能由于社会经济地位的改善和其他未明确的影响而对第一民族人群的身体健康有益，但我们的研究结果表明，这是以高昂的情感代价换来的。
